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WO2005088520A1 - Technique (assistance) de balayage iteratif d'analyse vertebrale automatisee - Google Patents

Technique (assistance) de balayage iteratif d'analyse vertebrale automatisee Download PDF

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Publication number
WO2005088520A1
WO2005088520A1 PCT/US2005/008311 US2005008311W WO2005088520A1 WO 2005088520 A1 WO2005088520 A1 WO 2005088520A1 US 2005008311 W US2005008311 W US 2005008311W WO 2005088520 A1 WO2005088520 A1 WO 2005088520A1
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WO
WIPO (PCT)
Prior art keywords
spine
program
search
spinal
discs
Prior art date
Application number
PCT/US2005/008311
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English (en)
Inventor
Kenneth L. Weiss
Judd M. Storrs
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University Of Cincinnati
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Filing date
Publication date
Application filed by University Of Cincinnati filed Critical University Of Cincinnati
Priority to US10/598,764 priority Critical patent/US8014575B2/en
Publication of WO2005088520A1 publication Critical patent/WO2005088520A1/fr
Priority to US12/155,803 priority patent/US8805042B2/en
Priority to US13/136,165 priority patent/US8457377B2/en
Priority to US13/848,638 priority patent/US9196035B2/en
Priority to US14/288,080 priority patent/US20140341457A1/en
Priority to US14/948,209 priority patent/US9754369B2/en
Priority to US15/694,940 priority patent/US10223789B2/en
Priority to US17/161,660 priority patent/US11948221B2/en

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Definitions

  • the present invention relates, in general, to medical diagnostic imaging devices that perform scout scans for localization and autoprescription.
  • the quality of the diagnostic image may vary depending on the source and type of imaging modality.
  • the presented image volume provided may not include the top and bottom vertebrae. Vertebrae and discs may not be adequately captured in the image due to congenital defect, disease, injury or surgery.
  • the individual in question may have an atypical number of mobile pre- sacral vertebrae, either more or less than 23. Further, the spacing and curvature of the individual's spine may be rather exceptional.
  • one image set is autoprescribed, it would be further beneficial to correlate with other types of imaging modalities that are also autoprescribed.
  • One advantage is that calculations of changes over time for the same patient may quickly identify injury or disease.
  • Another advantage is that different spectral emissions illicit different information about a tissue. Correlating between a plurality of imaging modalities, if a common tissue structure can be localized for each, may enable autodiagnosis as to whether the tissue is normal, benign or malignant. Consequently, it would be of a further advantage to extend spine autoprescription across multiple sources of diagnostic images.
  • the present invention addresses these and other problems in the prior art by providing an apparatus and method of localizing a spinal column of a patient with robust automated labeling of vertebrae across a population and across different imaging modalities facilitating autoprescription and follow-on therapeutic procedures. Thereby, human error in incorrectly identifying a vertebrae in an image, and thus mislocating a surgical site, is avoided.
  • an apparatus processed a medical diagnostic image of a patient's torso by identifying voxels of appropriate size to be putative spinal structures. Then disc constraints are applied to identify a long chain of spinal structures that are then labeled.
  • this processing is in conjunction with a localized coil placed on the torso of the patient that provides an external reference correlated to the identification and labeling, enabling accurate insertion or aiming of therapeutic treatments.
  • an entire spine can be effectively surveyed with sub-millimeter in-plane resolution MRI in less than one minute.
  • All cervical- thoracic-lumbar vertebrae and discs can be readily identified and definitively numbered by visual inspection.
  • All cervical-thoracic-lumbar vertebrae and discs can be readily identified and definitively numbered by semi-automated computer algorithm. Rapid technique should facilitate accurate vertebral numbering, improve patient care, and reduce the risk of surgical misadventure. Coupled with an integrated head and spine array coil, rapid computer automated iterative prescription and analysis of the entire neuro-axis may be possible.
  • FIG. 1 is a diagram of an automated spinal diagnostic system.
  • FIG. 2 is a flow diagram of a spine identification sequence or operations or procedure for the automated spinal diagnostic system of FIG. 1.
  • FIG. 3 is a diagram of a projection function of adjacent objects ( p and ( q represent the angles between the line connecting candidate disc p and q through their centroid and the major axis of disc p and q respectively, wherein 0 ⁇ ( p ⁇ 90° and ( p ⁇ 45° and ( p ⁇ 45° let d c be the value of d for any candidate disc in cervical- thoracic spine region and d L in the thoracic-lumbar spine, then 6mm ⁇ d c ⁇ 80 mm and 8 mm ⁇ d L ⁇ 100 mm.
  • FIG. 4 is a diagram of distance constraint chains with a cluster, k, is part of a disc chain if its closest superior neighbor has k as its closest inferior neighbor and k's closest inferior neighbor has (k) as its closest superior neighbor.
  • FIG. 5 is a 7-slice sagittal MRI projected image volume having a 35 cm FOV top half and FIG. 6 is a 35 cm FON bottom half illustrating typical search regions wherein voxels exceeding intensity threshold are depicted with those meeting additional disc constraints are highlighted as putative disks and connected by a curved line through their centroids.
  • FIG. 7 is a combined sagittal image depicting search paths parallel to the curved line of FIG. 6 connecting a centroid of a C2-3 disc with longest disc chains from top and bottom half images (FIGS.). Dots correspond to local maxima along these paths.
  • FIG. 8 is a sagittal image through the entire spine with all intervetebral discs auto-labeled with labeling of vertebrae omitted for clarity with three-dimensional (3-D) coordinates generated by an algorithm providing a means for discs or vertebral bodies to be labeled in any subsequent imaging plane providing no gross inter-scan patient movement.
  • FIG. 9 a sagittal image through the entire spine of a patient with 23 mobile/presacral vertebrae with correct auto-labeling of first 22 interspaces.
  • FIG. 10 a sagittal image through the entire spine of a patient with 25 potentially mobile presacral vertebrae with correct auto-labeling of the first 23 interspaces.
  • FIG. 11 a sagittal image through the entire spine of a patient with surgically fused L4-5 interspace and associated artifact from a metallic cage with correct labeling of all 23 interspaces including a good approximation of the L4-5 disc.
  • Fig 12 a sagittal image through the entire spine of a patient with vertebral planus of T-10 mislabeled due to a less robust disc discrimination process.
  • FIG. 13 is a sagittal image through the entire spine of the patient of FIG. 12 with correctly labeled vertebrae due to a more robust disc discrimination process including Gaussian filters.
  • FIGS. 14A-14I are diagrams of a point localizer;
  • FIG. 14A depicts a frontal view of the point localizer affixed to fabric;
  • FIG. 14B depicts a reverse side of the point localizer of FIG. 14A;
  • FIG. 14C is a perspective view of the point localizer and underlying fabric affixed to the skin;
  • FIG. 14D is an enface view of the fabric with corresponding marking affixed to the skin;
  • FIG. 14E is an enface view of the localizer affixed to skin;
  • FIG. 14F is a diagram view of a port integrated into a tubular ring;
  • FIG. 14G is a frontal view of a modified ring shaped localizer affixed to fabric with additional markings;
  • FIG. 14H is a frontal view of the fabric in FIG. 14G with the localizer removed;
  • FIG. 141 is a frontal view of a multilocalizer sheet demonstrating the adhesive backing and overlying
  • FIGS. 15A-15F illustrate a cross-shaped grid configuration
  • FIG. 15A is an enface view of the grid with modified square as the central hub and uniquely positioned rows of tubing radiating along the vertical and horizontal axes
  • FIG. 15B is a schematic of axial cross sections acquired at representative distances from the horizontal axis
  • FIG. 5C demonstrates the underlying marked fabric with the superimposed tubing in FIG. 15A removed
  • FIG. 15D is a variant of FIG. 15A with modified ring serving as a central hub
  • FIG. 15E depicts a limb fixation ring and angulation adjuster
  • FIG. 15F depicts a radiopaque grid with underlying ruled fabric strips removed.
  • FIG. 16A is an enface view of the grid/phantom configuration with tubular lattice, overlying a diagonally oriented slice indicator, and underlying a partially adhesive fabric with markings and perforations;
  • FIG. 16B is a schematic cross section of a representative axial section of the grid/phantom configuration of FIG. 16 A.
  • FIGS. 17A-17B are diagrams of localizers in a packaged strip or roll, regularly spaced at 5 cm or other intervals.
  • FIGS. 18A-18B are a lattice localizer having tube diameters varied to identify unique locations.
  • FIGS. 19A-19D are depictions of a full-spin grid localizer and spinal coil.
  • an automated spinal diagnostic system 10 includes a diagnostic imaging system 12 (e.g., MRI, CT) that is used to image a torso of a patient 14 that is advantageously covered by a skin/surface marking system 16 that serves as an integrated multimodality, multi-functional spatial reference.
  • the diagnostic imaging system 12 may include scanning of the skull 18, the full spine 20, and pelvic bones 22.
  • the diagnostic imaging system 12 serves as an automated MRI technique that rapidly surveys the entire spine providing accurate definitive numbering of all discs and vertebrae. In the particular illustrative version, the entire spine can be effectively surveyed with sub-millimeter in-plane resolution MRI in less than 1 minute.
  • C-T-L vertebrae and discs can be readily identified and definitively numbered by visual inspection or semi-automated computer algorithm ("ASSIST").
  • the diagnostic imaging system 12 may derive a sagittal image 28 of the torso 14 from a volume CT scan 30.
  • the diagnostic imaging system 12 may produce an upper cervical-thoracic sagittal image 32 and a lower thoracic- lumbar sagittal image 34, such as from MRI.
  • a spine autoimage processor 40 which may be a process hosted by the diagnostic imaging system 12 or by a remote device, performs a number of subprocesses to correctly identify and label the spine 20.
  • MRI studies were performed on a clinical 1.5T magnet with standard 4-channel quadrature array 6-element spine coil and surface coil correction algorithm.
  • Contiguous two- station 35 cm FON sagittal FGRE sequences were pre-programmed, providing full cervical, thoracic and lumbar (C-T-L) spine coverage.
  • Combined sagittal FON of 70 cm., 7 sections, L15-R15, 4 mm skip 1 mm; 512x352, 1 nex, TR 58, TE 2.0, 30° flip, BW 15.6; 21 sec x 2 stations 42 sec.
  • a line was drawn on the spine coil for the technologists to landmark (set as scanner's 0 coordinate) rather than have them use a superficial anatomic feature.
  • the coil has a contoured head/neck rest assuring grossly similar positioning of the cranial-cervical junction of each patient relative to this landmark.
  • the semi-automated disc detection and numbering algorithm of the spine image processor 40 was iteratively developed, tested and refined on batches of consecutive de-identified patient studies and results compared to neuroradiologist assignments.
  • the spine image processor 40 was implemented in MATLAB 7.
  • a computer algorithm is hosted on the spine image processor for the identification and labeling of disc and vertebrae from auto-prescribed sagittal MRI or sagittal auto-reformatted CT data, described in greater detail below.
  • This information may be advantageously provided to an automated spine image analysis algorithm 43 that further characterizes each disc and/or vertebrae level.
  • this information from block 41 may be advantageously provided to an auto-prescription algorithm 45 for additional image sequences, utilizing the identified spinal landmarks as references.
  • the additional processes 43, 45 may exchange information with each other, such as detained analysis and diagnosis of a particular vertebrae in block 43 being enabled by auto-prescribed detailed images in block 45.
  • a top vertebrae is identified, which may be automated in block 48 by interfacing with an automated cranium identification system, such as described in U.S. Pat. Appl. Ser. No. 10/803,700, "AUTOMATED BRAIN MRI AND CT PRESCRIPTIONS IN TALAIRACH SPACE" to Dr. Weiss, filed 18 March 2004, the disclosure of which is hereby incorporated by reference in its entirety.
  • logic may be incorporated into the spine image processor 40 wherein a spine algorithm in block 50 recognizes a top vertebrae.
  • a technologist input is received to identify the top vertebrae.
  • the neuroradiologist could readily visualize and definitively number all C-T- L levels on ASSIST localizers. 6/50 patients had a congenital shift in lumbar- sacral transition; 3 with 23 mobile pre-sacral vertebrae and 3 with 25 mobile pre- sacral vertebraeBased upon usual of manual placement of a single seed in the C2- 3 interspace for accurate identification and numbering of the other 22 discs, in the illustrative version with 50/50 cases performed by the spine autoprescription processor 40,. The automated disc detection and numbering algorithm was concordant with neuroradiologist assignments in 50/50 (100%) of cases.
  • a labeled disc image 64 With a labeled disc image 64, correct relative location to other imaged tissue of interest, depicted at 65 may be used for further diagnostic procedures or therapeutic intervention. For instance, in block 66 with an ability to correlate images taken with the same type of imaging modality at different times, growth progression of a suspicious lesion or changes due to an intervening injury may be compared between images. In addition, images taken with different imaging modalities may be cross referenced to perform multi-spectral diagnoses (block 68), wherein information on a type of tissue may be gained by its different responses to various types of electromagnetic spectra. With tissue diagnosis complete, in block 70 may correctly orient a therapeutic agent, such as the radiation device 28 or a guided minimally invasive surgical instrument (not shown). Alternatively, for an externally oriented procedure, a surgeon may reference either the relative location to a known spinal constituent (e.g., vertebrae) and/or reference the skin/surfacing marking system 16.
  • a therapeutic agent such as the radiation device 28 or a guided minimally invasive surgical instrument
  • the first batch of 27 cases was initially run with an algorithm 100 developed using previously obtained, non surface-coil corrected ASSIST images.
  • the first step we input cervicothoracic (top half), and thorariclumbar (bottom half) spines.
  • a threshold and a median spatial filter are applied to the search region.
  • additional disc constraints are applied to identify longest chain in top and bottom images.
  • Candidate discs must extend onto at least two adjacent slices. Objects at the boundary or touching the boundary of the search region are excluded. Different threshold values, and candidate discs' constraints are applied to the top, and bottom half image.
  • the automated disc detection and numbering algorithm 100 is a multi-step iterative process.
  • DICOM i.e., Digital Imaging and Communications in Medicine
  • ASSIST images of the cervicothoracic (top half), and thorarolumbar (bottom half) spine are first input into MATLAB 7 (The Math Works, Inc., ⁇ atick, MA) for digital image processing.
  • MATLAB 7 The Math Works, Inc., ⁇ atick, MA
  • these two data sets are processed to obtain putative discs separately, utilizing different threshold values and disc constraint parameters (block 104), with resulting upper and lower images 106, 108 depicted in FIGS. 5 and 6 respectively.
  • Image volumes 106, 108 are enhanced with a tophat filter and background noise is suppressed.
  • a posterior edge 110 of the back is then identified in each image 106, 108 and search regions 112, 114 assigned respectively.
  • the algorithm 100 thresholds and applies a median spatial filter to the search regions. Voxels 116 exceeding threshold values are then subjected to additional constraints.
  • Acceptable voxels 120 must extend onto at least two adjacent sagittal sections but not touch the boundary of the search region 112, 114 .
  • the acceptable voxels 116 must lie 6-80 mm in the cervicothoracic (C-T), and 8- 100 mm in the thoracolumbar (T-L) region from adjacent candidate voxels 120.
  • the centroids of these voxel clusters 120 (candidate discs) are then connected by curved line 122.
  • the angle subtended by the line 122 connecting the centroid of adjacent candidate discs 120 and the major axis of these discs 122 must be between 45° and 135° in both the C-T and T-L spine.
  • projection analysis is used to constrain disc assignments.
  • the technologist is instructed to approximate (click on) the centroid of C2-3 at anytime during or before the aforementioned candidate disc evaluation.
  • the centroid of C2-3 and the longest disc chains in the C-T and T-L spines are connected with a straight line.
  • the program searches along this line and twelve adjacent parallel lines 140, represented by only four in FIG. 7 for clarity due to their superimposition in the sagittal projection.
  • the algorithm 100 finds local intensity maxima along each path. Points 142 that are less than 7.5 mm apart are grouped into clusters. These clusters are analyzed based on orientation, eccentricity, and spatial relationship relative to other clusters (block 144 of FIG. 4).
  • the program 100 extends the search line inferiorly based on the estimated position (E X; y ) of the missing disc(s).
  • the algorithm 100 will determine in block 160 whether the last identified level (L4-5) satisfies criteria for the terminal pre-sacral interspace suggesting a congenital variant with 23 rather than the typical 24 mobile presacral vertebrae (block 162).
  • the centroid of the 22nd disc must lie within 25% of its expected location (Ex, y) relative to the 21st disc. Additionally, the centroid must lie posterior to the centroid of the 21 st disc and the slope of the 22 nd disc must be positive and greater than that of the 21 st disc.
  • the discs are labeled in block 168. Else, if the terminal disc criteria are not met in block 166, the position of the 23 rd (L5-S1) disc is estimated using Equation 2 (block 164), and search constraints refined. If the 23 rd disc is still not identified in block 166, the disc is presumed to be severely degenerated or post-surgical and the estimated position for L5-S1 will be accepted in block 170 and the discs thus labeled (block 172).
  • the algorithm was run on an INTEL (San Jose, California) personal computer with a 2.8 Ghz Xeon processor. Computer auto-labeling was compared to independent neuroradiologist assignments for each patient's study.
  • the automated spine MRI sequencing provided a robust survey of the entire C-T-L spine in 42 seconds total acquisition time. In all patients (50/50), the neuroradiologist could readily visualize and definitively number all C-T-L levels on the ASSIST localizers. These included six patients with a congenital shift in their lumbar- sacral transition; three with 23 mobile pre-sacral vertebrae (Fig 5) and three with 25 mobile pre-sacral vertebrae (Fig 6). Several patients had post-operative spines to include metallic instrumentation (Fig 7).
  • the ASSIST algorithm 100 was successful in all 50 patients studied, the 7 section sagittal acquisition would be expected to fail in subjects with severe scoliosis due to insufficient spine coverage. As such, if significant scoliosis is suspected, more sagittal sections could be auto-prescribed, the cost being a proportionate increase in scan time.
  • the automated disc detection/numbering algorithm 100 was designed to accept any number of sagittal sections, however, its accuracy in patients with severe scoliosis is unknown and parameter modifications might be required. Additionally, ASSIST algorithm 100 was designed and tested only on an adult population. Consequently, the algorithm would likely require additional testing and modifications to perform optimally in the pediatric population.
  • the illustrative disc detection algorithm 100 presently requires manual input of the most cephalad disc, C2-3, to achieve maximal accuracy, it should be appreciated that automated computer detection of this interspace may be implemented.
  • the C2-3 disc may be readily discerned on midline sagittal head images with a 22-24 cm FON (Weiss 2003, 2004) or ASSIST 35 cm FON cervico-thoracic spine images based on several unique features. These include the characteristic shape of the C2 vertebrae and relatively constant relationship to the skull base and cervico-medullary junction.
  • the ASSIST algorithm 100 has applications to other imaging platforms, such as CT, substituting automated sagittal CT spine reconstructions for the direct sagittal MRI acquisitions facilitating automated temporal comparisons, multi-modal multiparametric spinal analysis, and optimized intervention.
  • CT computed tomography
  • direct scanner integration and related algorithms for computer assisted diagnosis could eventually enable "real-time" automated spine image analysis and iterative scan prescriptions.
  • optimally angled axial oblique sequencing could be auto- prescribed through all interspaces or those discs demonstrating abnormal morphology or signal characteristics on the ASSIST or subsequent sagittal sequences.
  • Matlab code Matlab code
  • the point localizer 500 of FIGS. 14A-14I is a multimodality visible and compatible affixed to an adhesive fabric strip with corresponding markings so that after application and imaging the localizer can be removed with skin marking remaining.
  • the localizer can also directly adhere to the skin.
  • an ink or dye could be added to the adhesive/undersurface of the localizer to directly mark/imprint the skin obviating the fabric strip.
  • a small loop of tubing could be filled with a radioattenuative solution (e.g. containing iodine) doped with a paramagnetic relaxant (e.g. CuS04, MgS04, Gd- DTP A).
  • the tubing itself may be radiopaque for optimal CT visualization.
  • SPECT single photonuclide
  • a port would be included to allow filling with the appropriate radionuclide.
  • a fine wire circle or dot e.g. lead, aluminum
  • Other shapes and corresponding adhesive markings could be utilized to discriminate different foci and/or add further localizing capability.
  • an activatable chemiluminescent mixture could be added for thermography, optical imaging, light based 3D space tracking or simply improved visualization in a darkened environment.
  • a unique cross shaped grouping of prefilled or tillable tubing is utilized as a grid for cross sectional imaging with the number and position of tubes imaged in the axial or sagittal planes corresponding respectively to the slices z or y distance from the center.
  • a flexible radiopaque ruled cross shaped grid is employed for planar radiography. Both grids are removable from similarly ruled cross shaped adhesive strips after patient application and imaging.
  • a unique essentially planar grid/phantom which may be of flexible construction and reversibly affixed to an adhesive/plastic sheet with corresponding grid pattern for skin marking and to serve as a sterile interface between patient and reusable grid/phantom.
  • the grid/phantom may also be directly adherent to the skin for guided aspiration or biopsy with the cross sectionally resolvable spatial reference in place.
  • a diagonally oriented prefilled or tillable tube overlies a grid like lattice of regularly spaced tubing so that slice location and thickness can be readily determined in the axial and sagittal planes.
  • FIGS. 14A-14I depict an illustrative version of a point localizer 500.
  • FIG. 14A-14I depict an illustrative version of a point localizer 500.
  • a loop of prefilled tubing 510 (i.e., a tubal lumen shaped into a tubal ring) is shown superimposed on and reversibly affixed to an underlying medical grade fabric 511, which may double as an adhesive bandage to both cover and mark a wound or puncture site.
  • the diameter of the tubular ring 510 may be 2 cm mid luminal, as illustrated, or outer luminal, as perhaps preferable for integration with the cross shaped grid configuration. Other sized rings, to include in particular a 1 cm. diameter, may also have merit.
  • the tubal lumen should measure 2-5 mm in cross sectional diameter. Cross sectional images through the ring will have characteristic and quantifiable appearances depending on slice thickness and distance from the center. A thin slice through the loop's center, for example, would demonstrate 2 circles of luminal diameter whose centers are separated by a distance equal to the ring's diameter.
  • the tube lumen can be filled with an appropriate concentration of an iodinated contrast agent for optimal CT visualization doped with a paramagnetic relaxant such as CuS04,MgS04, or GdDTPA to maximize MRI signal via preferential TI shortening.
  • a paramagnetic relaxant such as CuS04,MgS04, or GdDTPA
  • the tubing itself may be optimally radiopaque for CT, obviating the iodinated contrast.
  • an activatable chemiluminescent mixture whose critical reagents are separated by a membrane readily breached by external force applied to the ring.
  • a slightly redundant backing 512 is provided for the adhesive side of the fabric 51 to facilitate peeling (FIG. 14B arrows) and skin placement.
  • the unit 500 adheres to skin 513 as depicted in FIG. 14C.
  • the loop 510 which has its own adhesive undersurface, may be removed revealing an underlying fabric marking 514 as in FIG. 14D.
  • the upper surface of the fabric, or circumscribed area thereof, may also have adhesive backing-like properties to facilitate detachment of the ring 510.
  • the loop 510 Once separated from the fabric, the loop 510 could also directly adhere to the skin 513 as in FIG. 14E.
  • the adhesive undersurface of the ring could contain a medical grade dye or ink so that a corresponding imprint would be left on the skin 513 after removal, potentially obviating the fabric marker.
  • a port 515 may be directly integrated into the tubular ring 510 as in FIG. 14F, and a vacuum created within the lumen to facilitate filling at the imaging center. This feature would be critical for radionuclide scans and add flexibility for other imaging studies.
  • the ring and underlying fabric marking may be modified as in FIGS. 14G and 14H.
  • two tubular spokes 516 at right angles to each other may be added with luminal diameter less than or equal to that of the loop.
  • the modified ring would be positioned on the patient so that the spokes are aligned at 0 and 90 degrees as perhaps determined by the scanner's alignment light. Subsequent rings could be progressively rotated 90 degrees so that quadrants I, II, III, and IN are sequentially subserved by the spokes. With the simple ring included, this would provide 5 distinguishable localizers.
  • FIG. 141 illustrates such a sheet, demonstrating adhesive backing 517 and overlying fabric 511 with the simple ring (left side) and modified ring (right side) localizers removed.
  • Tabs 518 have been added to the fabric to facilitate both removal of the unit from the backing and the localizer from the fabric. Discontinuity of the backing (solid lines 519) underlying the tabs would also simplify removal of the fabric from-the backing and perforations through the backing (dotted lines 520) would facilitate separation of individual units from each other. If desired, a smaller diameter (e.g.
  • FIGS. 15A-15F Embodiments of a prefilled or fillable cross shaped localizer grid 600 are illustrated in FIGS. 15A-15F.
  • a modified tubular square 621 with diagonal dimensions of 2 cm and containing 2 smaller caliber spokes 623 at right angles to each other serves as the hub.
  • Uniquely positioned rows of tubing (24) radiate from each corner along the vertical and horizontal axes.
  • the luminal diameter of the radiating tubes is uniform and on the order of 2 mm. except where indicated by dotted lines 625 corresponding to gradual tapering from 0 to the uniform diameter.
  • FIG. 15B Depending on the distance from the central hub, with 1 or 2 rows of tubing will be present with up to 4 tubes in each row as best illustrated in a table of FIG. 15B.
  • the lower row of tubes i.e. closest to skin
  • the upper row to increments of 5 cm so that a maximum distance of 24 cm would be denoted by 2 full rows.
  • the tubes are progressively ordered from left to right or down to up with the reverse true for negative distances as illustrated in FIGS. 15A-15B. Fractions of a centimeter would be indicated by the diameter of a cross section through a tapered portion of tubing divided by the full uniform diameter.
  • the cross-shaped grid of tubing is reversibly affixed to a medical grade adhesive fabric 626 with corresponding markings and backing.
  • the fabric 626 is illustrated in FIG. 15C with the overlying tubing removed.
  • the grid and associated fabric may come as a single cross-shaped unit or as a modified square and separate limbs which could be applied to the patient individually or in various combinations. Modified squares could also link whole units and/or individual limbs together to expand coverage, with 25 cm. spacing between the center of adjacent squares.
  • the tubing may be flexible to allow the limbs to conform to curved body contours such as the breast. Additionally, either the limbs could be readily truncated at 5 cm. intervals or be available in various lengths for optimal anatomic coverage.
  • a modified ring may serve as the hub of the cross-shaped grid with associated modification of the limbs as illustrated in FIG. 15D.
  • the orthogonal limbs would not have to maintain a coincident relationship to the spokes as with the modified square hub. Rather, by first placing and rotating a calibrated ring adapter (FIG. 15E) about the modified loop, 1 to 4 limbs could be readily positioned at any desired angle relative to the spokes. Pairs of male plugs 627 extending from the ring, adapter would fit securely into corresponding holes 628 at each limb base to ensure proper positioning.
  • a cross-shaped grid of radiopaque (e.g. lead or aluminum) dots at 1 cm intervals interposed by 5 cm spaced dashes would minimize the imaging area obscured by overlying radiopacity.
  • the minute opacities could be reversibly affixed by clear tape to an underlying marked adhesive fabric similar to that illustrated in FIG. 15C.
  • similarly spaced radiopaque dots and dashes could be dispensed reversibly affixed to a role of medical grade adhesive tape with corresponding markings. Any length of this dually marked taped could be applied to the patient to include a single dot as a point localizer.
  • a planar localizer grid/phantom 700 1 cm spaced horizontal and vertical tubes form a graph paper-like lattice as illustrated in FIG. 16 A. Tubes at 5 cm intervals (29) would have larger luminal diameters (e.g. 3 mm) than the others (e.g. 2 mm). Central vertical 730 and horizontal 731 tubes would have a smaller diameter (e.g. 1 mm). Overlying the lattice at a 45 degree angle is a slice indicator tube 732. Depending on the distance from the horizontal or vertical axes respectively, axial or sagittal cross sections through the grid/phantom (GP) would demonstrate the slice indicator tube 732 uniquely positioned as it overlies a row of 1 cm spaced tubes. FIG.
  • the GP may be reversibly affixed to an adhesive/plastic sheet with a corresponding graph paper-like grid for skin marking and to serve as a sterile interface between the patient and GP.
  • Perforations 733 may be placed in the sheet as shown in FIG. 16A to allow ready separation of a cross-like ruled adhesive fabric (similar to that illustrated in FIG. 15C), from the remaining plastic sheet after imaging and removal of the GP.
  • the square GP should have outer dimensions equal to a multiple of 10 cm (e.g. 30 cm as illustrated) to allow for simple computation if GPs are placed side to side for expanded surface coverage. Adapters could be provided to ensure secure and precise positioned of adjacent GPs either in plane or at right angles to each other.
  • the GPs can be flexible or rigid in construction and be utilized with or without skin adhesion and marking.
  • Tubes may be filled uniformly or with a variety of known solutions having different imaging properties to serve as multipurpose references.
  • the 5 cm spaced tubes and slice indicator may be filled with the same optimized solution as previously described, while each set of 4 intervening tubes could be filled with different solutions in similar sequence.
  • identical series of 5 reference solutions would repeat every 5 cm, allowing intraslice signal homogeneity to be assessed as well. If 9 rather than 5 different solutions are desired, sequences could instead be repeated every 10 cm.
  • the central tubes may also be surrounded by an oil/lipid within a larger lumen tube to serve as both a lipid signal reference and allow for measurement of the fat/water spatial chemical shift.
  • MR imaging could be improved by reducing skin/air susceptibility artifact and dampening motion.
  • the GP may also be incorporated into a variety of nonmodality specific pads (including the ubiquitous scanner table pad(s)), binders, compression plates, biopsy grids and assorted stereotaxic devices.
  • the ring localizers in a sheet as illustrated in FIG. 141, they could be packaged in a strip or roll 800, regularly spaced at 5 cm or other intervals (FIG. 17).
  • the strip 800 with attached ring and/or cross localizers could then serve as a linear reference of any desired length.
  • a cross-shaped grid is created. Individual rings can be removed from the strip or rotated to customize the grid as desired (FIG. 18).
  • an elongated rectilinear or cross configuration (FIG. 17A) is achieved consisting of linearly arranged squares extending vertically and/or horizontally from the central square.
  • One tube in each of these squares will have a larger diameter than the other similarly oriented tubes as determined by the square's distance from the isocenter.
  • the square centered 10 cm above the isocenter would have its first tube situated to the right of midline given an increased diameter and the square centered 20 cm above the isocenter would have its second tube to the right of midline given an increased diameter and so on.
  • FIG. 8B illustrates the cross sectional appearance of an axial section obtained 12 1/2 cm. above isocenter. By adding 2 1/2 (the slice indicator position) to 10 times 1 (the tube with largest diameter), distance is readily determined.
  • the caliber of all tubes could be kept constant and instead an additional diagonal indicator tube passing through isocenter added for each elongated axis (vertical with slope of 10 and horizontal with slope of 1/10). Cross- sectional distance from isocenter would then be determined by looking at the position of both the additional and original diagonal indicator tubes in reference to the cross sectionally-created number line.
  • localizer grids similar to those illustrated in FIGS. 16A-16B and 18 could be constructed of barium (or other high x-ray attenuative material) impregnated sheets rather than tubes if computed tomography is the primary imaging modality desired and phantom attenuation values are not needed. This would significantly reduce the cost of the grid, allowing disposability and retaining 1:1 compatibility with the multifunctional tube filled grid/phantom.
  • applications consistent with the present invention may be modified to include a sheath for and inclusion of a flexible array MRI surface coil. Positioned vertically, this device could be closely applied to the entire cervical, thoracic, and lumbar-sacral spine. Additionally, the quantity of tubes which need to be filled in the planar configuration to uniquely denote cross- sectional positioning, has been substantially reduced from the original embodiment.
  • Phased array surface coils significantly increase signal to noise in MRI and are commonly employed for spine imaging.
  • spine coils are rigid and planar in configuration.
  • patients can only be effectively scanned in the supine position, lying with the back against the coil. This results in signal drop-off in regions where the spine/back is not in close proximity to the planar coil, particularly the lumbar and cervical lordotic regions.
  • the invention, described herein, would reduce the signal drop-off and allow patients to be scanned in any position.
  • the prone position for example, would facilitate interventional spine procedures that could not be performed with the patient supine. Patients could also be more readily scanned in flexion or extension; or with traction or compression devices.
  • a grid-localizer would be adhered to the patient's spine.
  • Tubing would be filled with a MRI readily-visible solution such as water doped with CuSO4.
  • the grid itself would typically be 10 cm wide and 70-90 cm in length to cover the entire spine.
  • An attached clear plastic sheath would allow introduction of a flexible array coil such as illustrated in FIG. 9B.
  • the configuration of tubing would allow unambiguous determination of the MRI scan plane (axial or sagittal) in reference to the patient's back/skin surface.
  • the number of thin caliber tubes could denote the distance from (0,0) in multiple of 10 cm as illustrated in FIG. 9B (those to the right or superior would be positive; those appearing to the left or inferior would denote negative distances).
  • the integer distance in centimeters from a single thin tube to the central tube could be multiplied by ten to denote distance from (0,0).
  • 30 cm could be denoted by a single thin tube 3 cm from the central tube rather than by 3 thin tubes as in FIG. 9B .
  • FIGS. 9C-9D the integer distance in centimeters from a single thin tube to the central tube
  • 9C, 9D an axial slice taken 8 cm superior to (0,0), would reveal the cross sectional tubes illustrated in 6d.
  • the thin tube being 1 cm to the right of the central tube would denote a vertical distance of 10 cm.
  • the diagonal oriented tube in cross-section being 2 cm to the left of the central tube, would denote a vertical distance of -2 cm.
  • a diagnostic or therapeutic procedure could be performed under direct MR guidance.
  • the patient could be taken out of MRI scanner and have the procedure done with CT or fluoroscopic guidance. In either case, procedures could be performed by hand or with a robotic arm.
  • a fast rule-based spine contour extraction method has been developed. It consists of the following steps: (1) locating inter-vertebral disc locations; (2) finding the inter- vertebral contour using a deformable contour model; and (3) locating the vertebral boundary and the spine contour. This method enables automated scan prescriptions, real-time lesion detection, and examination tailoring.
  • the entire spinal axis can be interrogated in the sagittal plane in less than a minute.
  • the vertebral bodies and inter- vertebral discs can be identified and subsequently analyzed with the software proposed for development. Based on this initial assessment, regions of suspected pathology to include vertebral fractures and disc hernations, could be further interrogated with more dedicated computer driven prescriptions to confirm and better characterize pathology. If for example, a fracture is identified, additional multiparametric sequencing through the involved vertebrae would be obtained to determine whether the fracture was related to osteoporosis or underlying malignancy.
  • Osteoporosis is a disease characterized by low bone mineral density and abnormal bone microarchitecture. Currently, it affects about 30% of post- menopausal women, with more than 50% at risk. With our population rapidly aging, the prevalence of osteoporosis continues to rise. As osteoporotic-related fractures result in major morbidity, health care expenditures, and mortality in the elderly, this proposal addresses the DDF's desire to promote research in Aging- Geriatrics. Moreover, by applying cutting-edge investigational technology to this critical health-care problem, the study fulfills Translational Research Initiative goals as well.
  • the traditional criterion for assessing fracture risk is bone mineral density (BMD) as may be measured by single-photon abso ⁇ tiometry (SPA), quantitative computed tomography (QCT), single-energy x-ray abso ⁇ tiometry (SXA), and most commonly dual-energy x-ray abso ⁇ tiometry (DEXA).
  • BMD bone mineral density
  • SPA single-photon abso ⁇ tiometry
  • QCT quantitative computed tomography
  • SXA single-energy x-ray abso ⁇ tiometry
  • DEXA most commonly dual-energy x-ray abso ⁇ tiometry
  • a novel MRI technique improves current screening, assessment, and surveillance of the elderly at risk for osteoporotic spine fractures.
  • osteoporotic fractures result in major morbidity, health care expenditures, and mortality in the geriatric population
  • this proposal directly addresses the Dean's Discovery Fund's desire to promote research in Aging/Geriatrics.
  • the study fulfills Translational Research Initiative goals as well.
  • Osteoporosis and related fractures are a leading cause of morbidity, disability, decreased quality of life and mortality in the aged. ⁇ 2-4)
  • the wide range of therapeutic options available for prevention and tre atment require effective screening, assessment, and monitoring of geriatric patients at risk for osteoporotic fractures.
  • Conventional measurements including bone mineral density (BMD) analysis are imperfect predictors of fractures.
  • BMD bone mineral density
  • IVIRI-derived parameters hold promise for improved risk prediction and fracture evaluation.
  • the long term goal is to promote geriatric patient care by providing improved risk assessment, identiiication and characterization of fractures.
  • Osteoporosis is an important geriatric health issue and poses a most serious public health problem. With life expectancies increasing, the financial and human costs associated with osteoprotic fractures will multiply exponentially throughout the world. Nertebral fractures are strongly correlated with age (mean 65 years) but even more so with menopause. In the United States, one out of two women and one in four men over age 50 will have an osteoporosis-related fracture.
  • Osteoporosis is a metabolic disease characterized by low bone mineral density and abnormal bone microarchitecture increasing fracture risk.
  • the traditional criterion for assessing fracture risk is bone mineral density (BMD) as may be measured by single-photon abso ⁇ tiometry, quantitative computed tomography, single-energy x-ray abso ⁇ tiometry, or most commonly dual-energy x-ray abso ⁇ tiometry (DXA).
  • BMD bone mineral density
  • DXA dual-energy x-ray abso ⁇ tiometry
  • Fractures are the ultimate manifestation of lost bone structural integrity.
  • One fractured vertebra increases the risk of subsequent vertebral fracture 5-fold. Consequently, low resolution mo ⁇ hometric x-ray abso ⁇ tiometry and/or more precise high resolution conventional thoracolumbar spine x-rays are often ordered to supplement BMD measures.
  • Nertebral fractures are commonly assessed on x- rays semiquantitatively and reported using Genant's 0-3 grading scale with grade 1 corresponding to a fracture deformity of 20-25%. More mild deformities are typically not scored but are also somewhat associated with lower BMD and increased fracture susceptibility.
  • MRI has the unique potential to simultaneously quantify fractures; differentiate between osteoporosis and other underlying pathology, such as metastases; and appropriately target therapy such as vertebroplasty.
  • spinal MRI affords direct visualization of the intervertebral discs, spinal canal, bone marrow, and neural tissue. MRI can accurately quantify vertebral mo ⁇ hology. Cyteval and colleagues have recently demonstrated the accuracy and reproducibility of MRI for the determination of vertebral body dimensions. They also found that the sagittal midline area was highly correlated with whole vertebral body volume and that each vertebra was proportional to other vertebrae in the same individual.
  • MRI can also provide bone quality measurements related to osteoporosis.
  • MRI researchers have demonstrated improved fracture risk prediction by combining DXA measurements with Dixon sequence derived fat percentage — F% (positively correlated) and transverse relaxation rate — R2* (negatively correlated).
  • F% positively correlated
  • R2* transverse relaxation rate
  • the Dixon technique exploits the resonant frequency differences between fat and water to separate the water signal intensity from the fat signal intensity. This frequency difference is measured as a phase difference in the acquired data. Acquisition of three separate measurements or Dixon echoes allows generation of a water image, a fat image, and a magnetic susceptibility map from which F% and R2* can be derived. (6) [00117] To date, while promising, MRI examinations have been too time intensive and costly to justify for osteoporosis-screening. To rectify this important shortcoming, we propose integration of the three-point Dixon technique with our novel automated sub-minute sub-millimeter resolution total spine screen. This should afford rapid high-resolution assessment of both vertebral mo ⁇ hometry and bone quality.
  • the imaging parameters have been selected to emphasize contrast between vertebral discs and bodies with full coverage from the cervical spine through the sacrum in 42 seconds.
  • Three-Point Dixon Technique Sagittal FSE Dixon (7 slices; 4 mm skip 1 mm; 44 cm FON) covering T4-S1 and prescribed using the superior ASSIST station as localizer.
  • the Dixon technique exploits molecular resonant frequency differences between fat and water to produce high resolution fat, water, and transverse relaxation rate (R2*) images.

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Abstract

Un système de localisation vertébrale automatisée, de numération et d'autoprescription permet d'améliorer la localisation correcte de tissus malades ou lésés, et permet même le diagnostic multispectral. La localisation depuis l'extérieur, de ces tissus, est facilitée par un système de marquage cutané et de référence spatiale auto-adhésif intégré, qui est conçu pour différentes modalités comprenant l'IRM, la tomographie par ordinateur, la tomographie monophotonique d'émission, la tomographie par émission de positons, l'imagerie nucléaire plane, la radiographie, la tomographie aux rayons X, la thermographie, l'imagerie optique et le suivi spatial 3D. Le dispositif peut s'étendre d'un localisateur de point à un système plus multifonctionnel et complexe grille/fantôme. La/les référence(s) spatiale(s) de conception particulière, est/sont apposée(s) à une bande de matière adhésive avec des repères correspondants de sorte que, après application de l'unité sur la peau/surface et imagerie, la référence peut être retirée en laissant une marque appropriée sur la peau. Le localisateur peut lui-même adhérer directement à la peau après détachement de la bande de matière sous-jacente. Un processus d'autoprescription vertébral comprend la mise en oeuvre d'une analyse d'image qui permet l'identification de vertèbres et de disques même en la présence d'anomalies.
PCT/US2005/008311 2004-03-11 2005-03-11 Technique (assistance) de balayage iteratif d'analyse vertebrale automatisee WO2005088520A1 (fr)

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US10/598,764 US8014575B2 (en) 2004-03-11 2005-03-11 Automated neuroaxis (brain and spine) imaging with iterative scan prescriptions, analysis, reconstructions, labeling, surface localization and guided intervention
US12/155,803 US8805042B2 (en) 2004-03-11 2008-06-10 Composite image generation and interactive display technology
US13/136,165 US8457377B2 (en) 2004-03-11 2011-07-25 Method for automated MR imaging and analysis of the neuroaxis
US13/848,638 US9196035B2 (en) 2004-03-11 2013-03-21 Computer apparatus for image creation and analysis
US14/288,080 US20140341457A1 (en) 2004-03-11 2014-05-27 Composite image generation and interactive display technology
US14/948,209 US9754369B2 (en) 2004-03-11 2015-11-20 Computer apparatus for analyzing medical images for diffusion-weighted abnormalities or infarct and generating prescriptions
US15/694,940 US10223789B2 (en) 2004-03-11 2017-09-04 Computer apparatus for analyzing multiparametric MRI maps for pathologies and generating prescriptions
US17/161,660 US11948221B2 (en) 2004-03-11 2021-01-28 Computer apparatus for analyzing CT and MRI images for pathologies and automatically generating prescriptions therefrom

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US20210280299A1 (en) 2021-09-09
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US8805042B2 (en) 2014-08-12
US20140341457A1 (en) 2014-11-20
US20070223799A1 (en) 2007-09-27
US10223789B2 (en) 2019-03-05
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